Thawing the Big Freeze
Horrible. Excruciating. Awful. These are just a few of the adjectives used to describe the pain of “frozen shoulder” by people who suffer from this mysterious condition.
Liz Trahan of Lake Charles is one of those people. She had been noticing some pain, especially during the night, in her shoulder for a couple of months, but ignored it – as most busy, working parents are likely to do. Then she fell recently while running up a set of stairs in her home and landed on her shoulder. “It was terrible. My hand and fingers felt numb, while my upper arm and shoulder were in almost unbearable pain. I thought if I gave it a day or two, it might ease up and eventually go away. Instead it continued to hurt and throb.” Because of the previous pain, she had not been using her arm to the full extent and now with the pain from the fall she could barely even move her arm. Routine things such as reaching out the car window to get the mail or using the ATM machine were nearly impossible without experiencing intense, severe pain. “I knew then that this was more than a bruise or pulled muscle that I could ignore until it went away,” she said.
Trahan sought the help of orthopaedic surgeon and shoulder specialist J. Trappey, MD, with Center for Orthopaedics. After a physical exam and x-ray, he gave her the diagnosis: frozen shoulder.
Dr. Trappey explains that frozen shoulder, also known as adhesive capsulitis, is one of those conditions that even doctors find puzzling because they can’t pinpoint what triggers the problem, or why some people develop it and others don’t.
“The bones, ligaments and tendons that make up your shoulder joint are encased in a smooth capsule of connective tissue,” he explains. “Frozen shoulder occurs when this capsule becomes inflamed, thickens and tightens around the shoulder joint, restricting its movement. It doesn’t strike the same shoulder twice, but at least 15 percent of patients eventually develop the problem in the opposite shoulder.”
There are certain groups that are more likely to develop frozen shoulder. Seventy percent of patients with the problem are women between the ages of 40 and 60, which indicates that hormones are a factor. Diabetics have a twenty percent higher risk and having an underactive thyroid is also a risk factor. It’s more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture. And, as in Trahan’s case, trauma or injury sometimes precedes a frozen shoulder.
“Beyond that, it’s difficult to predict who will get adhesive capsulitis, or how severe a case,” says Dr. Trappey. “We do know that the condition typically develops in three stages, with each phase lasting several months. Signs and symptoms often begin gradually, worsen over time and then resolve slowly, usually within one to two years.”
During the painful stage, there is pain with any movement of the shoulder and the range of motion begins to be restricted. In most cases, the pain is worse at night. The next stage is the frozen stage in which pain may begin to diminish while the shoulder becomes very stiff. Range of motion becomes severely limited. This is followed by the thawing stage when range of motion begins to return.
Frozen shoulder is usually diagnosed with a physical exam and x-ray. In some cases, further imaging tests may be needed to rule out other problems.
Dr. Trappey says the reason the condition takes so long to resolve is that people don’t seek treatment when they first notice symptoms. “If we can treat people at the beginning of the first phase with a cortisone injection into the shoulder joint, we can often derail the course of frozen shoulder.”
Studies have found if this injection is done in the earliest stages of adhesive capsulitis it can prevent collagen buildup and lead to dramatically faster recovery – a month or two compared to a year or longer. “The key is getting patients to come in soon enough to get this early treatment,” says Dr. Trappey.
In addition to cortisone injections, frozen shoulder treatment usually involves physical therapy/stretching exercise and anti-inflammatory pain medications. In a small percentage of severe cases, surgery may be needed to loosen the joint capsule to restore mobility.
Trahan had a cortisone injection in mid-January and is currently undergoing physical therapy and doing at-home exercises to preserve her range of motion. “So far, so good, although I won’t say that this is a pain-free regimen. But it’s worth it to avoid dealing with this problem for the next two years. I’m glad I didn’t put off going to see a doctor.”